New Complication from Contaminated Cocaine - Bilateral Necrosis of the Ear Lobes and Cheeks

Interesting fact: Traces of cocaine taint up to 90% of paper money in the United States. Paper money become contaminated with cocaine during drug deals and directly through drug use, such as snorting cocaine through rolled bills. Amounts of cocaine found on U.S. bills ranged from 0.006-1,240 micrograms of cocaine per banknote (50 grains of sand) (

Since 2005, levamisole (commonly used as to treat worm infections in humans and animals), has increasingly been used to mix cocaine for street use.

In 2009, 70% of cocaine seized at U.S. borders contained levamisole, causing an increase in cases of neutropenia among cocaine abusers.

Recently, researchers observed a new complication of levamisole contamination – vasculitis. Two cocaine abusers with similar cases of neutropenia and vasculitis presented to the University of Rochester Medical Center within 8 days of each other - with purplish plaques on their cheeks, earlobes, legs, thighs and buttocks. While the patients were not tested for levamisole levels, exposure was likely due to recent cocaine use.

Doctors should suspect levamisole exposure in patients presenting with both neutropenia and necrotic skin lesions.

See the dramatic photos from a similar case published in the NEJM here: Toxic Effects of Levamisole in a Cocaine User

Bilateral Necrosis of Earlobes and Cheeks: Another Complication of Cocaine Contaminated With Levamisole. Ann of Int Med, June 1, 2010,  vol. 152  no. 11  758-759.

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